Numerous states have passed expanded the dental workforce statues, allowing dental hygienists to deliver patient services to underserved children without direct supervision by a dentist. Outcomes and the cost of these policy changes in relation to eliminating oral health disparities in children are unknown. The objectives of this application are to 1) quantify the oral health and social outcomes relevant to the population of low-income, vulnerable children that are associated with expanding the dental workforce and, 2) undertake a cost analysis in a state where expanded dental hygiene workforce policy has demonstrated sustainability. For the U2 phase of this project we propose to complete three tasks: (1) Create and/or validate data collection instruments to measure relevant clinical, social and cost outcomes of children served by a statewide ECP program; (2) Establish collaborations with ECP programs (n=17) and school districts (n=108) to develop a statewide data collection strategy to evaluate clinical, social and cost outcomes of children served by a statewide ECP program; (3) Develop an appropriate curriculum to train ECP RDHs (n=41) as data collectors. For the UH3 phase of this project we propose to conduct a comprehensive, longitudinal, mixed methods policy outcomes evaluation on dentally underserved children (n=12,000). Three specific aims will accomplished during this phase: (1) Apply the multilevel Children's Oral Health Framework to identify the impact of the ECP workforce policy on children's primary and secondary oral health outcomes; (2) Conduct a cost analysis of oral health care provided by ECP RDHs; (3) Formulate evidence-based recommendations for developing dental workforce policy and delivery designs that can support oral health workforce changes, scope of practice changes, possible legislation and necessary infrastructure needed to achieve the Triple Aim. The proposed project is significant because it addresses a strategy to decrease oral health disparities in a population of low-income, largely minority children; it is innovative in its abiliy to leverage pre-existing relationships in a state with an existing oral health delivery system outside the structure of traditional private practice. The multi-disciplinary research team, assembled from academic, governmental, and practice settings, is well-positioned to successfully complete this research; expertise in dental workforce, community research, project evaluation, health policy, and cost analysis will allow us to address the core functions of the proposal. Results from the proposed research will be used to inform health policy and allow for rapid translation into oral health workforce practice, as well as advancing Goal 3 of NIDCRs Strategic Plan, Apply rigorous, multidisciplinary research approaches to overcome disparities in dental, oral and craniofacial health. The varied contributions and perspectives of the multidisciplinary team will ensure results that can be applied to oral health policy. This contribution can be expected to help advance the field of health disparities research and the NIDCR's mission because findings would allow for rapid translation into oral health workforce practice and policy.